The main entrance to MedStar Washington Hospital Center. (Jacquelyn Martin/Associated Press)

Persistent water and sewage leaks in and around the operating rooms of Washington’s largest hospital are at the center of a lawsuit seeking millions in damages in the infection-related death of a retired Northern Virginia schoolteacher.

The lawsuit comes after D.C. health inspectors last year found that MedStar Washington Hospital Center had not ensured a safe, sterile environment for patients. Investigators reported at least seven sewage leaks during an 11-month period, and during a tour last summer described a “black, grainy, foul smelling substance” on the floor between two operating rooms.

Sewage leaks, including from clogged toilets, were common enough that hospital employees referred to the problem as “black water,” according to an August 2017 report from the D.C. Department of Health.

A hospital spokeswoman said Monday that there have been no new leaks since the report and that the medical center is in “full compliance” with a follow-up plan accepted by the health department.

Gerard Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, said contamination of an operating room by sewage was “an egregious problem” that “should absolutely never occur in a hospital.”

The problem, he said, was remarkable in light of widespread efforts to reduce infections contracted at hospitals, which kill tens of thousands of people annually in the United States.

“That’s just beyond the pale of what would be expected in the 21st, or even the 20th century. Maybe in the 19th century it would have been okay, but not anymore,” Anderson said of sewage leaks.

With more than 900 beds, Washington Hospital Center is the District’s largest hospital by a sizable margin — with 50 percent more beds than the next-largest facility, MedStar Georgetown University Hospital. MedStar says it takes care of a half-million patients a year at its hospitals and other medical facilities in Maryland and the D.C. region.

Located off North Capitol Street, the hospital center attracts large numbers of poor patients and draws predominantly from Southeast Washington. A recent report on health-care needs in Wards 7 and 8 found the hospital center was the most popular option among residents for medical care.

The hospital center was also the facility where Rep. Steve Scalise (R-La.) was treated after being shot at a congressional baseball practice in June.

In its written response to the August report from the health department, the hospital said its leadership “considers water intrusion as serious occurrences” and details steps taken in response to ensure patient safety. “Leaks and floods affecting patient care areas are considered emergencies” and “response is expected within 30 minutes.”

The health department’s findings became public after a records request by an attorney for the family of Carol Leonard, who died early last year, days after undergoing thyroid surgery at the hospital during the time the leaks were reported.

Arlington-based attorney Scott M. Perry said in the March 15 lawsuit, first reported by USA Today, that the hospital intentionally withheld information from Leonard about the problems affecting its basement-level operating rooms.

“Hospitals compete for patients’ business these days and patients have a right to look into this information and to make their own choices,” Perry said in an interview Monday. “By keeping this from the Leonard family, they did not get to make the decision whether to go forward at this hospital.”

Leonard’s doctor, Perry said, also should have prescribed antibiotics before surgery to prevent infection particularly because of the sewage and water leaks. Leonard was more prone to infection, her lawyer said, because she was obese, had diabetes and was 70.

Hospital spokeswoman So Young Pak declined to comment on the lawsuit, but said, “We are very sorry for the loss the Leonard family has experienced.”

Pak characterized the center’s problems as “minor leaks in an operating room.”

“We closed the room immediately, conducted necessary repairs, cleaned and sterilized it, and brought in an outside hygienist to ensure that the room was safe for patient care,” she said in a statement.

In January 2017, Leonard, who taught a popular children’s knitting class in Alexandria after retiring, was being treated following a diagnosis of early-stage thyroid cancer. Her doctor recommended removal of the thyroid and some surrounding lymph nodes, and she was scheduled for surgery the following month.

The grandmother of six had gone to water aerobics and a grandchild’s birthday party the day before the procedure. Her husband, Eugene, was told he would be able to take her back to their Falls Church home the day after the surgery, the court filings state.

Instead, early that morning, Leonard showed signs of a sepsis — a complication of an infection — with breathing problems and a high pulse rate, according to the lawsuit. She was moaning throughout the night, vomited 10 times and required oxygen, the lawsuit states.

Carol Leonard’s family says the hospital failed to provide a safe, sterile operating room and should have responded more quickly when her surgical wound became infected. Her condition deteriorated and she died six days after the procedure. The lawsuit seeks $20 million, in addition to punitive damages.

Perry said he does not know at this early stage in the litigation, while he is awaiting responses from the hospital, whether Leonard was operated on in one of the rooms with reported leaks.

Had Leonard known about problems with leaks in the operating rooms, her husband said, she would have chosen another hospital.

“This is not supposed to happen in America,” he said in an interview Monday.

In September 2016, five months before Leonard’s surgery, the D.C. health department division that inspects and licenses hospitals in the city issued a 102-page report on infection-control problems at the hospital center.

Six months after Leonard’s procedure, the health department issued another report identifying “leaks and floods affecting patient care.” The hospital failed to “adequately address and curtail recurring sewage leaks, in the operating room, displaying a pattern of ineffective infection control precautions and potentially exposing patients to microbial contamination,” according to the report.

As part of the investigation, inspectors spent several days in August 2017 observing, reviewing documents and interviewing staff. Repair records showed “water intrusions” and sewage leaks in part because of toilets clogged with non-flushable wipes used by staff to care for patients.

Seven patients had surgery in an operating room during or in proximity to the time of the leaks, the report says, referring to complaints of “water coming from the wall.”

The health department issued a warning to the hospital Aug. 18 that put its Medicare and Medicaid funding at risk if problems were not quickly fixed. Administrators responded with a “corrective action plan” later that day and the warning was removed three days later, according to the report.

Pak, the hospital spokes­woman, said the facility is fully licensed and undergoes regular review for “providing a safe environment for every patient.”